Low Use of Oral Anticoagulant Prescribing for Secondary Stroke Prevention: Results From the Ontario Stroke Registry. Issue 10 (October 2016)

• Record Type: Journal Article
• Authors: Shah, Reema; Li, Shudong; Stamplecoski, Melissa; Kapral, Moira K.
• Is Part Of: Medical care. Volume 54:Issue 10(2016)
• Publication Date: 2016-10
• Subjects: stroke -- atrial fibrillation -- oral anticoagulants; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000589
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Oral anticoagulation reduces the risk of stroke in atrial fibrillation but is often underused. Objectives: To identify factors associated with oral anticoagulant prescribing and adherence after stroke or transient ischemic attack (TIA). Research Design: Retrospective cohort study using linked Ontario Stroke Registry and prescription claims data. Subjects: Consecutive patients with atrial fibrillation and ischemic stroke/TIA admitted to 11 stroke centers in Ontario, Canada between 2003 and 2011. Measures: We used modified Poisson regression models to determine predictors of anticoagulant prescribing and multiple logistic regression to determine predictors of 1-year adherence. Results: Of the 5781 patients in the study cohort, 4235 (73%) were prescribed oral anticoagulants at discharge. Older patients were less likely to receive anticoagulation [adjusted relative risk (aRR) for each additional year=0.997; 95% confidence interval (CI), 0.995–0.998], as were those with TIA compared with ischemic stroke (aRR=0.904; 95% CI, 0.865–0.945), prior gastrointestinal bleed (aRR=0.778; 95% CI, 0.693–0.873), dementia (aRR=0.912; 95% CI, 0.856–0.973), and those from a long-term care facility (aRR=0.810; 95% CI, 0.737–0.891). After limiting the sample to those without obvious contraindications to anticoagulation, age, dementia, and long-term care residence continued to be associated with lower prescription of oral anticoagulants. One-year adherence to therapy was similar across most patient groups. Conclusions: Age, dementia, and long-term care residence are predictors of lower oral anticoagulant use for secondary stroke prevention and represent key target areas for quality improvement initiatives. Abstract : Supplemental Digital Content is available in the text.